Clinical Outcomes of a Multidisciplinary Copd Inpatient and Transition Pathway

1UC San Diego Health Systems, San Diego, CA
2UC San Diego Health Systems, La Jolla, CA
3UC San Diego Health System, San Diego, CA

Meeting: Hospital Medicine 2015, March 29-April 1, National Harbor, Md.

Abstract number: 70



Patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are at high risk for readmission. In September 2012, a COPD longitudinal inpatient pathway and transition (CLIPT) was implemented at a 552-bed academic tertiary care medical center, created by a collaboration of hospitalists, pulmonologists, respiratory therapists, pharmacists and information systems specialists. We demonstrated previously that CLIPT improved adherence to international guidelines but did not significantly reduce readmission rates.

Methods: After instituting the initial computerized order entry clinical pathway that standardized pharmacologic therapies, respiratory care interventions and ancillary services, a multidisciplinary group instituted further enhancements based on QI methodology.  These including improvements in pathway penetration, AECOPD identification and linkages to a newly-established airway clinic established in November 2013. We analyzed subsequent outcomes, including 7- and 30-day readmission rates, length of stay and mortality using risk-adjusted data from the University HealthSystem Consortium (UHC) database. Hospitalizations that included time in ICU were excluded in a subanalysis. AECOPD hospitalizations were identified by using ICD-9 billing codes.

Results: Over a 30-month period, 864 AECOPD non-ICU hospitalizations were identified. Overall, inpatient order sets were used in 27% of AECOPD hospitalizations but rose to 41% in the last 6 months. Order set usage was associated with slightly shorter length of stay (3.85 days vs. 3.96 days), lower 7-day readmission rate (7.4% vs. 9.1%), but similar 30-day readmission rate (23.6% vs 24.0%). Mortality was lower with order set usage (0% vs 1.73%). Airway clinic utilization since its inception in November 2013 was low with a 16% referral rate after AECOPD hospitalization and a subsequent 20% successful attendance rate. The 30-day readmission rate for patients who successfully attended the clinic during the study period was 5.7% 

Conclusions: Implementation of CLIPT was associated with small reductions in length of stay, 7-day readmission rate, and mortality, although 30-day readmission rate was unchanged. Utilization of the order set and successful referral to the post-discharge clinic was low, but the latter was associated with a reduction in 30-day readmission rates. To address these shortcomings and further improve pathway penetration and transitions of care, a pilot program of a respiratory therapist COPD coordinator is planned to improve adherence to CLIPT, communication between inpatient and outpatient providers, and patient-centered education.

To cite this abstract:

Chang W, Hochstein G, Liang N, Clay B, Maynard G, Ford R, Limberg T. Clinical Outcomes of a Multidisciplinary Copd Inpatient and Transition Pathway. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 70. Journal of Hospital Medicine. 2015; 10 (suppl 2). Accessed September 20, 2019.

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